Court prohibits customer plan transfer

A worker’s client has obtained an injunction in court that prevents her health plan from being transferred to any other health care provider. work was he moved After the company Move your portfolio of individual and family plans to APS (Personal health assistance). Lawyers say the decision is a positive point for the consumer, but that it has inconsistencies.

On March 16, TJ-SP (São Paulo State Court of Justice) gave a favorable opinion of an Amil user. In addition to preventing your consent from being handed over to another company in the sector, Judge Demetrius Zarvos Varels, of Eleventh Civil Court, gives Factor five days to restore coverage to non-accredited hospitals and laboratories with a change of command and county previously contracted monthly fees.

Failure to comply with the court order results in a daily fine of R$10,000 to R$500,000. When contacted, an operator did not respond until this text was posted.

The recipient, a 67-year-old woman who preferred not to disclose herself, tells UOL who went to a medical appointment in late 2021 and was told by an attendant that her plan had been pulled from the hospital. This report was Submitted by different factor clients who heard the report Since APS took over the business.

The elderly woman began using the services of Amil in 2006, after Porto Seguro sold her individual wallet to a competitor. Currently, she is paying R$10,000 per month to cover her and her children’s healthcare.

“I was surprised because this had never happened before. The girl thought [do hospital] He gave me wrong information,” he says.

The decision applies only to the customer

I contacted the law firm of Vilhena Silva, which specializes in the right to health. Lawyer Rafael Ropa, a spokesperson for Vilhena Silva, says the court’s decision is a victory for his client, but maintains that the injunction is valid only for her. Amell can appeal.

He explains, “It is a temporary decision that is valid until it is canceled or confirmed, and it can be final even if there is an appeal, or the judge can invalidate it if a worker presents elements that convince the judge of the opposite.”

In the document, Judge Varellis tracks a timeline with facts dated between November 2021 and February 2022 that includes the health worker’s movements.

It brings the emergence of Fiord Capital, the company that will be responsible for the acquisition of Amil’s portfolio, and Transfer of 337 thousand contracts From Emile to APS and Comment by ANS (National Agency for Complementary Health) to acquire corporate control of the company for one set of two companies – Including Fiord – and legal entity.

According to the text, the decision refers to the uncertainty about the provision of services to the customer in an appropriate manner. “Amil has moved its entire portfolio of individual and family plans unreasonably fast (only four months) and without demonstrating to thousands of consumers the robustness and reliability of the companies involved in the business.

Melissa Kanda, an attorney specializing in medical law, declared the injunction an advance in consumer protection, as Agent’s clients have accumulated complaints about loss of rights. Portfolio transferred to APS includes users from São Paulo, Rio de Janeiro and Parana.

He added, “I don’t think this order will also be canceled due to the bad reputation [do assunto] in the media.”

The lawyer sees the blows and misses

In the opinion of Gustavo Martinelli, a lawyer who specializes in economic law, the injunction has some flaws. He says it cannot be said that a customer will not be able to rent a similar health plan without the high cost and long grace periods, as stated in the document.

Martinelli, for example, cites Standard Resolution 438/18 From the ANS, which allows the possibility of transferring grace periods as long as the health plan is active, paid on time and with a duly fulfilled length of stay, ranging from two to three years.

“If it were moved to another plan, it wouldn’t need to meet the grace period. Or even if it wanted to rent a third plan in the market,” he says.

The lawyer declares that Emile will try hard to overturn the injunction, believing that the arguments used in the end in the judicial decision of an individual case will serve as material for other rulings, the so-called judicial precedent.

Even if the order is temporary, the injunction will lose its effect if the transfer of the portfolio from APS to the business group is approved, Martinelli says.